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What is Congestive Heart failure ?
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what is the most common cause of CHF in infants ?
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Patel CHF in peds
Pediatric Congestive Heart failure
| Question | Answer |
|---|---|
| What is Congestive Heart failure ? | d/o of circulation in which cardiac output is inadequate to support the body's circulatory and metabolic needs. |
| what is the most common cause of CHF in infants ? | Blood volume overload. |
| What are sx of CHF in infants | The infant tires easily especially during feeding. |
| What are manifestations of CHF | weight loss, lack of growth, sweating, irritability, frequent infections. |
| what are clinical manifestations of CHF in older children | exercise intolerance, dyspnea, abdominal pain or distention, and peripheral edema. |
| As CHF progresses, what sx are manifested | tachypnea, tachycardia, pallor, cyanosis, nasal flaring, grunting, retractions, cough, crackles, FVO, periorbital and facial edema, hepatomegaly (FVE) JVD in older children. |
| __________ is enlargement of the heart by hypertrophy of its walls, occurs as the heart attempts to maintain CO. | Cardiomegaly |
| If CHF is not tx, cardiogenic shock may occur; what are the sx of CS | cyanosis, weak pulses, cool extremities, hypotension, heart murmur |
| what are dx test for CHF | based on clincal manifestations like tachycardia, resp distress and crackles. Chest radiograph, echocardiography, electrocardiogram |
| What are the goals of clinical therapy for CHF | make the heart work more efficiently and to remove excess fluid. |
| What kind of diuretics cause K+ loss? | Furosemide and chlorothiazide (K+ supps may be ordered) |
| What kind of diuretic does not cause K+ loss? | spironolactone. |
| what kind of medications are used to lessen the heart's workload and help it to work more efficiently ? | Inotropic medicine (improve velocity of contractility) and ACE inhibitors (reduce afterload) |
| What kind of drug is most commonly used to improve the heart's contractility and increase heart output? | Digoxin (NOT DIGITOXIN) |
| What is the surgical tx of choice for a congenital heart defect ? | correctional surgery or interventional cardiac catheterization |
| what kind of children might benefit from a heart transplant ? | end stage cardiomyopathy or complex congenital heart defects like hypoplastic left heart syndrome. |
| what is other types of supportive medical therapy for CHF? | airway management, ventilatory support, rest and fluid, diet, oxygen, Most children improve rapidly after meds are adminstered. |
| as diagnosis of CHF depends primarily on ________ nursing observations are important. | physical sx |
| What med increases myocardial contractility by improving systemic circulation? | Digoxin |
| What diuretic promotes rapid diuresis | furosemide |
| what kind of diuretic is used for maintenance, decreases absorption of NA, water, K+, Cl, and HCO3 in renal tubules ? | thiazides |
| this med promotes vascular relaxation and reduced peripheral vascular resistance. | ACE inhibitor |
| Beta blocker that increases contractility | Propanolol |
| Medication that improves left ventricular function, promotes vasodilation of systemic circulation for chronic heart failure and dilated cardiomyopathy | carvedilol |
| what is the physiologic assessment in a child with CHF | vitals, behavior, cardiac , resp, fluid status, detailed hx of onset of sx, (CHF develops slowly over time) |
| testing of developmental skills should be done with the __________ test. | Denver II |
| What is the primary nursing dx for CHF | decreased cardiac output r/t cardiac anomaly. |
| What should you do before giving the digitalizing dose of digoxin ? | get baseline vitals, quality of pulses, clinical sx, and ECG, serum electrolytes, hepatic and renal fx, hydration and hypovolemia. |
| what should you do before giving any dose of digoxin? | take apical pulse for 1 minute. |
| Before giving a dose of digoxin, you take the apical pulse and find that pulse is less than 60-100bpm or below 60 in teens, what should you do? | Hold the medication |
| Changes in heart rhythm and quality are noted before giving digoxin, what should you do ? | hold the medication and call a physician for advice. |
| Children with CHF usually recieve ________ and _______. | digoxin and furosemide |
| Signs of digoxin toxicity are ___________ . | Early sign is arrhythmias. |
| Serum digoxin levels are taken ______ hours after dose. | 6-8 |
| What is the therapeutic serum level of digoxin? | 0.8-2ng/ml |
| what level of serum digoxin is considered toxic in children ? | 2ng/ml and higher. |
| Serum digoxin levels should be closely monitored when child is also taking what? | antibiotic therapy because altered intestinal flora might precipitate digoxin toxicity. |
| What are nsg interventions r/t monitoring fluid status | I and O, wieighing infant diapers, 1g=1ml of urine, assess edema, and circulation, daily weights, |
| What should you do if child has abdominal ascites ? | measure abdomen every day. |
| What should you do to prevent skin breakdown when edema is present ? | turn the child freq. and provide skin care. |
| What position promotes the maximum level of oxygenation in a child ? | semi-fowlers or 45degree angle |
| What is the importance of monitoring side effects of digoxin and K levels ? | prevent injury |
| child should recieve ____________ to prevent overexertion of the heart . | rest periods each hour |
| What is a sign of increased respiratory effort ? | diaphoresis. |
| an infant should be held at what position during feeding ? | at a 45 degree angle |
| How should a child with CHF be fed throughout the day ? | small frequent meals with rest periods in between |
| What should be expected if child is not gaining weight ? | NG feedings supplemental |
| feeding should last no longer than ________ | 20-30 minutes. |
| children should engage in what kind of activity? | quiet activites like watching tv or playing board games, no aggresive or horseplay kind of stuff. |
| what kind of exercises should children do to promote large muscle development without over exerting themselves ? | sitting, standing, walking for short periods with adequate rest afterwards. |
| Breast feeding should be encouraged because ______________ | breast milk reduces infections because of antibodies and it is naturally low in NA. |
| What are the manifestations of a deteriorating cardiac status while feeding ? | decreased intake, vomiting, sleeing through feedings, increased perspiration. |
| The most important thing to teach when sending a child home to the parents is to teach _______ and ______. | administration of medications and signs of worsening condition. |
| What are the sx that CHF is worsening ? | feeding difficulty, irritability, lethargy, breathing difficulty, puffiness around eyes or extremities. |
| An ______ in pulse rate can signal CHF and a ________ can indicate digoxin toxicity. | increase, decrease |
| do not give any herbals with digoxin because it may cause ___________. | toxicity |
| Digoxin should be administered at ________ each day and consistent in ___________ meals . | same time, before or after |
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puja
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